Abstract

Background

High center procedural volume has been shown to reduce postoperative mortality (POM); however, the cause of POM has been poorly studied previously. The aim of this study was to define the pattern of POM and major morbidity in relation to center procedural volume.

Methods

Data from 2,944 consecutive adult patients undergoing esophagectomy for esophageal cancer in 30 centers between 2000 and 2010 were retrospectively collected. Data between patients who suffered 30-day POM were compared with those who did not. Factors associated with POM were identified using binary logistic regression, with propensity matching to compare low- (LV) and high-volume (HV) centers.

Conclusions

The results of this large, multicenter study provide further evidence to support the centralization of esophagectomy to HV centers, with a lower rate of morbidity and better infrastructure to deal with complications following major surgery preventing further mortality.

Keywords

On behalf of the FREGAT (French Eso-Gastric Tumors) Working Group – FRENCH (Fédération de Recherche EN CHirurgie) – AFC (Association Française de Chirurgie). The FREGAT working group – FRENCH – AFC Collaborators’ list is given in Appendix.

Notes

Conflicts of interest

None.

Funding Sources

None.

Appendix 1

Surgical Complications

Anastomotic leak was defined as any esophagogastric anastomosis dehiscence that was clinically symptomatic (abscess, mediastinitis, digestive liquid externalizing drainage) or asymptomatic detected by contrast study. In case of doubt, the diagnosis was confirmed by gastroscopy without insufflation performed by an experienced physician.

Surgical site infection was defined as superficial pus expressed from the abdominal, thoracic, or drains incision sites, requiring surgical debridement and antibiotic treatment.

Chylothorax was suspected when a major pleural effusion was seen in the first postoperative week upon resumption of feeding, and was defined by the presence of pleural or abdominal fluid, rich in chylomicrons and lymphocytes.

Gastroparesis was defined as the occurrence of vomiting after removal of the nasogastric tube or distension of the gastric conduit on plain radiograph after day 5 postoperatively, requiring repositioning of the nasogastric tube despite prokinetic treatment.

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